Individual
MISS ANITA PEARL JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
700 KNUCKOLLS AVE, BOLIVAR, TN 38008
(731) 658-4707
Mailing address
6388 BENT OAK LN, MEMPHIS, TN 38115-6414
(901) 794-3998
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA0000002221
TN
Other
Enumeration date
08/28/2008
Last updated
08/28/2008
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